January 20, 2019

Risk Factors for Conduct Problems

By Mihai Simionescu MD By MS
Complexity rating Intermediate
Evidence High Evidence
Read time 7 minutes

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Like with other disorders, we do not know precisely why a certain child will develop Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD). But we do know about risk factors and protective factors. A risk factor is a fact about somebody’s life that increases the risk of developing a condition. For example having a low weight at birth is a risk factor for developing a number of disorders including ADHD and CD. This is also an example of an unchangeable risk factor because, people who were born with a low weight cannot change that fact. Other risk factors are modifiable like ‘being rejected by peers’ that is a risk factor for ODD and depression. It may not be easy, but it is certainly possible to look for another set of peers who can be more generous.

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This is very important to understand because, like with many other things, some are in our power to change and some are not. If someone we love has a problem we naturally look into what we could do to help. Otherwise said, we want to see which of the present risk factors can be reversed in a way to become protective factors.

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The risk factors for the development of ODD and CD can be organized in four groups: biological, individual, familial and social factors. Below you can find the most common ones.

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The biological risk factors are the best example of things we cannot change. Many of them can be identified from birth while some are about problems that may develop in early childhood.   

 

  • One or both parents had ODD or CD in their youth
  • One or both parents had substance use problems
  • Mom has a diagnosis of depression and/or anxiety

Especially a problem when associated with other risk factors like single parenting.

  • The child had low birth weight
  • There were complications during pregnancy or around the time of delivery
  • The child has been exposed to lead.
  • The child had a brain injury or a brain disorder
  • The child has ADHD

Having ADHD is a major risk factor for developing ODD at some point during childhood.

  • Male gender

Boys are just more likely to have behavioral problems…

  • Girls with early physical maturation 

Physical maturity does not come along with emotional maturity or mature self-control…

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The individual risk factors are a mixed bag of individual past experiences, psychological traits or deficits in basic abilities.

 

  • The child has a history of abuse or neglect
  • The child has any developmental or learning disability
  • The child has a ‘difficult’ temperament 
  • Is either very emotional, very intense, very reactive or very inflexible
  • The child has a language impairment
  • Has a hard time describing facts (what happened?)
  • Has a hard time describing inner states (what he/she feels or thinks?)
  • Has a hard time understanding other people (how they feel, why they do what they do) 
  • Has poor social skills (especially conflict management skills)

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A number of family situations and types of relationships are often related with behavioral problems.

 

  • Past or present exposure to domestic violence
  • Past or resent exposure to high levels of domestic conflict (disrespect, put-downs, frequent loud angry tone of voice etc.) 
  • Single parenting

Especially when mom (usually) is depressed and young and struggling…

  • Early motherhood
  • Sibling relational problem

Competitiveness, envy and jealousy

  • Low supervision by the parent

Do I know where the child is? Do I know what games he plays, what movies he watches, what social media he is using, what friends is he communicating with?

  • Parenting style

If I would be the parent of a child who is getting to be increasingly testy and oppositional with me, I would do anything in my power to avoid an escalation of conflict in our relationship. Conflict begets more conflict. Remember, this is not about ‘setting things straight’ but about modeling that oppositionality, defiance and conflict are for the most part, NOT the best ways to achieve our goals and relate with other people.

For this reason a parenting style that is very controlling and demanding will lead to more conflict and bring more defiance with time. Harsh discipline, with a focus on punishment is HIGHLY associated with behavioral problems. In general, punishment is a tricky card to play especially for the kids who are not sensitive to it. 

What I mean is that a majority of kids will respond to punishment by ‘stopping to do’ what got them in trouble. Odds are though that if the child has ODD he is not a punishment responder. He will continue to do what he did despite the punishment, forcing you to increase punishments higher and higher hoping to get him to ‘understand’. 

If your child is not a punishment responder you got to use punishments sparingly and think about other strategies.

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Last, but not least, there a social risk factors for the development of ODD and CD.

 

  • The child hangs out with peers who already have conduct problems
  • The child is/has been rejected by peers
  • The child is/has been bullied by peers
  • The child is exposed to a lot of media violence
  • The child has a dysfunctional or disorganized school
  • The child/adolescent has easy access to drugs
  • The child/adolescent is economically disadvantaged.

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This has been the second part about defiant and/or aggressive behaviors. The general idea to keep, I think, is that the overall level of risk can often be managed by focusing on the factors that are more likely to be reduced or corrected. Forging good, nurturing relationships with these defiant kids is probably the most important thing to do, and this should start wherever it is possible, be it at home, in the community, in school or in a mental health clinic. 

In the third part will talk about the way these difficult behaviors shift and change over childhood and adolescence.

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